How do you  clean a bathtub? Normally, you use a hard brush, plenty of elbow grease and a lot of abrasive cleaner. However, that is not how you want to clean your teeth unless you want to wear them away. We discussed the type of tooth brush to use (soft) in our first post and how much force you should use when brushing in our second post.

This post deals with the type of toothpaste (abrasive cleaner) you use and how much. I used to think the type of toothpaste or how much didn’t matter, but after years of observation and research, I now think it matters. I have come to the conclusion that the abrasiveness of toothpaste can effect the rate of gum recession and tooth structure loss.  The abrasiveness of a toothpaste is especially important if you already have recession exposing the softer part of the tooth.

 

 

Some studies question whether we need to use toothpaste at all. In many studies, dry brushing without paste has been shown more effective at removing bacteria than brushing with toothpaste. So, why do we use toothpaste? It makes our mouths taste better, which, of course, is great marketing by toothpaste companies. So, aren’t all toothpastes pretty much the same? According to each manufacturer, their toothpaste is unique and the best. Our main concern in this blog is the abrasiveness of different tooth pastes and the effect this could have on recession. As you can see from the attached table, the abrasiveness of toothpastes varies widely from 40 to 200. The exact number means little, but a comparison gives us good information. Look your tooth paste up and see where it falls on the scale. My suggestion would be to avoid the highly abrasive toothpastes especially if you have recession or wear. Perhaps, I am being overcautiuos as the American Dental Association sets an upper limit on toothpaste abrasiveness at 250, but it never hurts to be informed. I find it interesting that many of the “whitening” tooth pastes are the most abrasive. The patients who buy these are concerned with their oral hygiene and prone to overzealous brushing to begin with and often unaware that as they wear away their enamel their teeth actually get darker not lighter. They also often present with significant recession.

 Toothpaste Abrasiveness Index,  Low is better

04      Toothbrush with plain water	91      Aquafresh Sensitive
07      Plain baking soda	93      Tom’s of Maine
15      Weleda Salt Toothpaste	94      Rembrandt Plus
30      Elmex Sensitive Plus	95      Oxyfresh with Fluoride
30      Weleda Plant Tooth Gel	95      Crest Regular
35      Arm & Hammer Dental Care	97      Oxyfresh Powder
40      Weleda Children’s Tooth Gel	101     Natural White
42      Arm & Hammer Mentadent Advance Whitening	103     Mentadent
44      Squiggle Enamel Saver	103     Arm & Hammer Sensation
45      Weleda Calendula Toothpaste	104     Sensodyne Extra Whitening
45      Weleda Pink Toothpaste with Ratanhia	106     Colgate Platinum
45      Oxyfresh	106     Arm & Hammer Advance White Extreme Whitening
48      Arm & Hammer Dental Care Sensitive	107     Crest Sensitivity Protection
49      Tom’s of Maine Sensitive	110     Colgate Herbal
52      Arm & Hammer Peroxicare Regular	~80     Amway Glister
53      Rembrandt Original	113     Aquafresh Whitening
53      Closys	117     Arm & Hammer Advance White Gel
54      Arm & Hammer Dental Care PM Bold Mint	117     Arm & Hammer Sensation Tartar Control
57      Tom’s of Maine Childrens	120     Close Up with Baking Soda
62      Supersmile	124     Colgate Whitening
63      Rembrandt Mint	130     Crest Extra Whitening
68      Colgate Regular	133     Ultra Brite
70      Colgate Total	144     Crest Multicare Whitening
70      Arm & Hammer Advance White Sensitive	145     Ultra Brite Advanced Whitening Formula
70      Colgate 2-in-1 Fresh Mint	150     Pepsodent
78      Biotene	65     Colgate Tartar Control
79      Sensodyne	168     Arm & Hammer Dental Care PM Fresh Mint
80      AIM	176     Nature’s Gate Paste
80      Close Up	200     Colgate 2-in-1TartarControl/Whitening
82      Under the Gum
83      Colgate Sensitive Max Strength	200     FDA recommended upper limit
87      Nature’s Gate	250     ADA recommended upper limit

 

How much toothpaste should I use?

 

Of course, toothpaste companies want you to use as much paste as possible. They want to sell toothpaste. The classic picture of the toothpaste completely covering the head of the toothbrush is overkill.

 

 

 

 

 

 

 

 

 In reality, the toothpaste only needs to be a small amount especially if the major benefit is simply to freshen our mouth.  The additional paste is just additional abrasive cleaner and does little to help clean the bacteria off our teeth. The extra abrasive can also result in increased tooth structure loss and recession. Excess toothpaste also produces excess foam and the need to spit, creating a mess. As an aside,the foam producing compound sodium laryl sulfate has been linked to canker sores, so if you are prone to them, avoid toothpastes containing it.

 

At this point I am not going to get into the controversy about fluoride, I will save that for a later blog. I will simply say I believe fluoride has health benefits for your teeth and that my family uses fluoride containing toothpastes to protect and strengthen our teeth. The paste does make our mouth taste cleaner but has very little additional cleaning benefit except the fluoride.  The fluoride in tooth paste is antibacterial and remineralizes your teeth. You could get the same effect by simply using a fluoride mouth wash. Perhaps, someone with no recession or roots exposed can use any toothpaste they want, but when I see a patient who already has recession, I do think it matters because the soft part of the tooth, the root is exposed.